N.C. question proposed changes to the military's Tricare health system

By DREW BROOKS | The Fayetteville Observer, N.C. | Published: March 9, 2014

Members of Congress who represent Fort Bragg are pressing defense officials for answers about changes to a military healthcare program.

U.S. Sens. Richard Burr and Kay Hagan and U.S. Reps. David Price and Renee Ellmers were among the more than 50 members of Congress to sign a letter sent last month to Secretary of Defense Chuck Hagel.

The lawmakers said they had concerns regarding Tricare's change in reimbursement policy to exclude certain medical tests from coverage.

Those tests include molecular pathology laboratory tests, or MoPath, and other laboratory developed tests, or LDTs. The tests are used to screen for cystic fibrosis, Fragile X Syndrome, spinal muscular atrophy and common cancers.

Reimbursement for some of those tests stopped in 2013, according to the letter. Others are covered only if they are done in a military treatment facility.

In the letter, lawmakers said they are concerned the new policy creates two levels of care within the military health system: one for those with access to military hospitals and another for those who do not.

During a Senate Armed Services Committee hearing Wednesday, Hagan, a Democrat, asked Hagel about the letter and told him of two examples where families were effected by the changes.

In one example, a military couple expecting a baby was tested prior to 2013 and learned they were both carriers for a gene thought to cause cystic fibrosis.

"This testing was covered by Tricare at the time," Hagan said. "Based on these findings, the delivery location was moved to a hospital with neonatal intensive care facilities, and the baby was born in a setting that was able to address a life threatening complication from cystic fibrosis immediately." "If these circumstances were to occur today, these same cystic fibrosis tests would not be covered by Tricare, and, if not performed, the baby might have been born in an inappropriate delivery setting."

In the other example, Hagan said a military retiree in remission from leukemia was billed more than $1,000 for a blood test needed to monitor his cancer because the test was no longer covered by Tricare.

"These tests provide useful information to help physicians determine the best course of treatment for their patients and are widely considered by the medical community to be the normal standard of care," Hagan said. "Tricare needs to move quickly and reverse this decision so that those who have sacrificed so much for our country are not forced to pay out of pocket or forgo them altogether."

In a release, Burr, a Republican, also weighed in on the issue.

"Our military's health insurance should adhere to the widely held standards of care accepted by the medical community at large," he said. "Our members of the military and their families should have the same access as other government employees and civilians in the private sector and not be penalized for receiving care at a private facility."

The letter, signed by 26 Democrats and 25 Republicans, poses four questions to Hagel and requests an answer by Friday.

The letter asks about Tricare's policies for a notification or public comment period for policy changes, what feedback was considered before the change, Tricare's justification for the changes and the Tricare appeals process for services that are not covered by the program.

During Wednesday's hearing, Hagel said changes to Tricare were required for the Department of Defense to find the money to protect training and readiness under tight budgets.

"In recent years, Congress has permitted DoD to make some changes that slow the growth in military health care costs; however, these costs will continue to grow, and we need to slow that growth in order to free up funds for training and readiness," Hagel said. "So we need to make some additional smart, responsible adjustments to help streamline, simplify and modernize the system while encouraging affordability."

Hagel said more than 90 percent of active-duty service members and their families live within 40 miles of a military treatment facility.



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